Rationale

How and why the Dental Prevention Dashboard works

1. Gingivitis is reversible

Gingival bleeding on probing or interdental cleaning is a sign of gingivitis, a bacterially driven inflammatory process caused primarily by plaque. In a landmark experiment, Löe et al. demonstrated in 1965 that gingivitis is fully reversible with consistent plaque removal.^[1] Abbas et al. confirmed in 1990 that mechanical oral hygiene measurably reduces bleeding scores.^[2]

This is the biological foundation of the dashboard: the condition seen daily in the dental practice can, in most patients, be reversed at home by the patient themselves.

2. There is not enough time

Clinical schedules are organised around the downstream consequences of insufficient plaque control: filling cavities, charting pockets, slowing attachment loss. That work is indispensable. But primary prevention — bringing about behaviour change in daily home habits — does not fit structurally within the time allocated to a consultation. A dentist or dental hygienist provides instruction, but cannot guide behaviour change week by week.

This is not a local problem. Across dental systems in Europe and North America, preventive oral care consistently represents a small fraction of clinical time and reimbursement. In the Netherlands, based on claims data and own research, primary prevention (patient instruction and coaching) accounts for an estimated 2.5% of total adult dental turnover; secondary prevention (professional cleaning) for approximately 22.5%; the remainder is restorative and surgical treatment. A survey of 53 dentists and dental hygienists confirms this picture and shows why. (see Survey preventive dentistry 2023 — in Dutch)

Motivational Interviewing has attempted to close this gap and demonstrates measurably better outcomes than standard instruction — but MI requires trained therapists and consultation time that a dental practice structurally cannot provide.

3. A forty-year gap

The simple indices for plaque and bleeding that are suitable for routine repeated measurement in individual patients all date from the period 1964–1985: the OHI-S (Greene & Vermillion, 1964^[3]), the BOP (Ainamo & Bay, 1975^[4]), the API (Lange, 1977^[5]), and the EIBI (Caton & Polson, 1985^[6]). In 1996, the American Academy of Periodontology convened the World Workshop in Periodontics, from which the international classification by Armitage (1999^[7]) emerged. This classification established the six-point full-mouth periodontal charting at all present teeth as the diagnostic standard for periodontal status.

Since 1999, simple periodontal screening indices have been introduced internationally — PSR (USA), BPE (UK), PSI, and PPS — but these measure probing depth on a 0–4 scale and serve exclusively to determine whether a full periodontal examination is required. They are triage instruments, not monitoring indices. For plaque and bleeding — the daily behaviours that cause gingivitis and over which patients have direct influence — no new simple routine index has been developed since the EIBI in 1985. Nor does any clinical guideline exist stating: at score X, take measure Y.

That gap — no simple routine index for plaque and bleeding, no threshold-based guideline — is precisely what the PAI and PBAI fill. The full periodontal assessment remains the gold standard; PAI and PBAI do not compete with it. They fill the space that has existed for forty years: routine, repeatable, outside the clinical context.

The PAI (Plaque Awareness Index) is methodologically a 10-point simplification of the API. The PBAI (Papillary Bleeding Awareness Index) is methodologically based on the EIBI. Both indices measure plaque and bleeding dichotomously at ten fixed interproximal points — buccal only, from distal to mesial: five spaces in quadrant 1 and five in quadrant 4, starting at the most posterior fully erupted tooth. For home measurement — as used in mijngebit — the anterior region from canine to canine is the preferred location. For the PAI, the patient applies a disclosing solution; per space the question is: plaque present or not. For the PBAI, the interdental papilla is mechanically stimulated — with an interdental brush, toothpick, or floss — and the presence of bleeding is recorded. The EIBI used exclusively a wooden toothpick; the PBAI accepts all common interdental instruments, making the index more broadly applicable in practice.

In children with a primary dentition — where the buccal surfaces are more representative due to the flatter interdental contact — the PAI may be performed on the buccal surfaces.

Both indices can be performed by any qualified team member in approximately two minutes.

Because PAI and PBAI both measure interproximally, they form a cause-and-effect pair at the same anatomical location: interproximal plaque (PAI) and the resulting bleeding tendency (PBAI). The same ten points at every measurement ensure longitudinal reliability for an individual patient. The dashboard measures change over time — not absolute values, and not comparisons between patients.

The PBAI scale — 0 to 100% in steps of 10% — is an original contribution. A percentage scale of this kind for routine assessment of interdental bleeding has not been described in the literature. The thresholds align with the API band classification of Lange (1977):^[5] ≤20% = Optimal; 30–40% = Fair; 50–60% = Insufficient; ≥70% = Poor. The only deviation: 40% falls in the "Fair" band rather than "Insufficient" — a deliberate rounding choice on the 10%-step scale, scientifically defensible and intentionally accessible to a broader population than the strict clinical norm.

4. Behaviour change: Self-Determination Theory

Knowledge about plaque and bleeding is not sufficient for lasting behaviour change. The Dental Prevention Dashboard is grounded in Self-Determination Theory by Deci & Ryan^[8] — a well-researched theory of intrinsic motivation and sustainable habit change in healthcare.

SDT identifies three fundamental needs that support behaviour change:

• Autonomy — the patient sets their own pace. The dashboard does not prescribe; it informs. You facilitate the conversation, not the decision.
• Competence — the patient sees their own scores as a trend graph, complemented by clinical photographs. Progress becomes visible not six months later at the next appointment, but at the moment you review the graph together.
• Relatedness — the patient dashboard carries the branding of your practice. The patient sees their results within an environment you have created.

5. Mirrors, not teachers

The dashboard design follows the principle of "mirrors, not teachers": the system shows patients their own data without directing, comparing, or judging. The graph reflects. The team member is the one who can provide explanation.

The dashboard contains no elements that invite clinicians or patients to adjust measurement outcomes: no "best month" cards, no rankings, no score-based badges. A clinician pursuing a score badge risks — consciously or not — influencing measurements. The PAI/PBAI methodology requires objective registration.

6. Feedback at the right moment

Bandura's research on self-efficacy showed that visible progress builds the expectation of personal competence — the strongest predictor of persistence.^[9] Feedback is most powerful at the moment behaviour is still forming: not as a conclusion after the fact, but as direct confirmation while the patient is engaged. The patient who sees their own bleeding graph while you are sitting beside them experiences exactly that — visible evidence that their own effort is having an effect. The trend graph is not a report; it is an instrument that moves patients from passive to active. The moment a patient looks at their own graph and asks a question is the beginning of behaviour change that lasts.

7. Early recall

The dashboard includes an optional early recall function: the ability to offer a patient with a high bleeding score a follow-up appointment within 14 days.

The biological rationale: Löe et al. established in 1965 that gingival tissue requires two weeks to recover with consistent oral hygiene.^[1] On day 14, the outcome of the patient's efforts — if they have maintained interdental cleaning — is measurable for the first time. A follow-up measurement at that point yields objective clinical data and gives the patient the first concrete confirmation that it is working.

The early recall function also serves as a research instrument: the dashboard records the acceptance rate and PAI/PBAI outcomes for early versus standard recall. The comparison between both groups is one of the primary research questions of the platform.